the recovery of individuals with disabilities following disaster laura m. stough, ph.d. elizabeth h....

The Recovery of Individuals with Disabilities Following

Disaster

Laura M. Stough, Ph.D.

Elizabeth H. Ducy, M.Ed.

Texas A&M University

Photos credit the Associated Press

A rescuer carries a young man who is unable to walk to safety.

http://www.gov.state.la.us/assets/images/photogallery/Katrina/8.28.07.jpg

Photos from: http://www.nod.org/katrinaphotos/katrina9.jpg

Tanisha Blevin, 5, holds the hand of fellow Hurricane Katrina victim Nita LaGarde, 105, as they are evacuated from the Convention Center in New Orleans, La., Saturday, Sept. 3, 2005. (AP Photo/Eric Gay )

Hurricane Katrina Resulted in the loss or destruction of housing for

over 1.5 million individuals

Estimated that 23% of those people affected were individuals with disabilities (National Organization on Disability, 2006)

Discussion Point #1 Hurricane Katrina occurred in an area of the

country that is vulnerable to hurricanes In the past 30 years, Louisiana has been hit by

11 hurricanes with three being rated as Category 3 storms (Blake et al, 2007)

What are some disasters that could occur where you live?

Types of Disasters Floods Tornados Fires Earthquakes Hurricanes Ice Storms Tsunami Flu outbreak Terrorist attacks

Katrina Aid Today

A National Case Management Consortium

Implemented by UMCOR and Consortium Partners to Assist

Katrina-Displaced PersonsKatrinaAidToday.org

Goal UMCOR, in cooperation with FEMA, formed a

Consortium as lead agency The consortium, Katrina Aid Today, includes 9

members to provide case management Cost: $66 million Time: 24 months

National Disability Rights Network

The goal of Katrina Aid for Individuals with Disabilities is to provide high quality, cost-effective nation-wide case management services for displaced individuals with disabilities and their families.

Design of EvaluationI. Survey of 50 case managers providing services as part of

Katrina Aid TodayII. Face-to-face interviews with 15 case management supervisors

and administratorsIII. Quantitative analysis of types and costs of case management

services received by 63,759 families affected by Hurricane Katrina

IV. Five focus groups in Texas, Louisiana, Mississippi, and Georgia with 31 people with disabilities

Analysis of Quantitative Data Extracted data on 63,759 families who had

received case management services through Katrina Aid Today

Database relied on input from case managers

Descriptive statistics Between groups (NDRN clients versus KAT

clients) analyses

66%

34% 28%

72% 72%

26%

3%

74%

26%

55%45%

81%

12% 7%

*Numbers in parentheses are cases for which data are available

Percents of KAT clients shown by demographics

NDRN (5,257)* Partners (58,502)*

12%

87% 88%

18%6%

61%

1%13%

94% 90%

59%

8%

82%

2%

injured physically

or mentally

displaced residence damaged

loss of income

loss of loved one

mandatory evacuee

emegency relief

worker

*Numbers in parentheses are cases for which data are available

Percents of KAT clients shown by Katrina Impacts

NDRN (2,680)* Partners (44,050)*

Discussion Point #2 Displacement was the largest impact felt by

clients Displacement includes housing issues and was

the second largest concern What would you do if your house was damaged

from a disaster? What would be your plan?

Housing Issues Shelter Family/ Friends Temporary Housing Repairs New housing Finances Relocating

Discussion Point #3 A large percentage of the clients were

mandatory evacuees It is likely that you will have to evacuate in the

event of a catastrophic emergency What would be your needs in an evacuation?

Evacuation needs Durable Medical Equipment Medical supplies Medicine Communication Personal Care Service animal Transportation Disaster Kit or Go Kit Varies from individual

Discussion Point #4 The cases were open an average of 6 to 7

months.

Think back to your housing plan. Would your plan work for an extended amount of time?

66%

22% 19% 15%

32%

15%

53%

31%22% 24%

45%

16%

*Numbers in parentheses are cases with at least one need recorded

Percents of clients shown by types of Property Needs

NDRN (2,596)* Partners (44,275)*

40%

23%12%

4%

19%33%

27% 25%

8% 4%

*Numbers in parentheses are cases with at least one need recorded

Percents of clients shown by types of Personal Needs

NDRN (2,596)* Partners (44,275)*

Similar to clients of the other partners, NDRN clients were1:

Predominantly female and predominantly African American; Nearly all displaced and had experienced damage to housing; NOT likely to have lived in subsidized housing pre-disaster; Likely to have their case open an average of 6 to 7 months; Not likely to have their case referred to Long Term Recovery

Committee; Likely to have “primary needs met” or “recovery plan achieved” as

the reason for case closure; Likely to indicate satisfaction with their case manager and with

services received.

1 X2 analysis found no significant difference found between groups given p<.05

In contrast to clients of the other partners, NDRN clients were:

Older (F=1576.80, p<.001);

More likely to need housing (X2=4.07, p<.05);

Less likely to have experienced loss of income (X2= 33.70, p<.001) ;

Less likely to need employment/job training (X2=4.77, p<.05).

Of particular note-- NDRN clients were less likely to express satisfaction

in how other agencies assisting in their recovery had responded (X2= 9.90, p < .01) .

Throughout the KAT program as a whole, the average number of months a case was opened was significantly greater for those clients with aged/disabled service needs Clients with disabilities had cases opened an average of 8.86

months while others had their case opened 7.82 months (F=270.21, p<.001, eta squared=.040

An additional 42% of cases had yet to be closed

Implications Needs of individuals with disabilities differ

significantly in a number of key areas that have implications for both case management and resources needs during the long term recovery phase post-disaster

Recovery can be assumed to take longer, require more expensive resources, and demand more intensive case management

Focus Groups of Individuals with Disabilities Five focus groups: Houston, Baton Rouge, New

Orleans, Gulfport, and Atlanta Each group consisted of three to eight group

members Five questions presented to each group with follow-

up probes

Analysis of Qualitative Data

Line-by-line analysis of qualitative data Open coding Axial coding Relationship among the categories determined

Focus Group Disability Category

1 12

4

7

16

02468

1012141618

VI LD Mobility MentalIllness

MedicalNeeds

Multiple

Focus Group Ethnicity

African American

84%

European American

13%

Unidentified3%

African American

European American

Unidentified

Focus Group Questions1. What has helped you recover from Hurricane

Katrina?

2. What help or services have helped you get the things you need?

3. What have been things that prevented you from recovering?

Focus Group Questions1. What have been things that prevented you from

recovering?

2. What has helped you recover from Hurricane Katrina?

3. What help or services have helped you get the things you need?

What have been things that prevented you from recovering? Lack of concrete resources

Housingthey tore my house down just about three weeks ago and she is going to use my insurance money to help get me a handicap accessible home not the trailer I am in…You know, I have a trailer, and I just appreciate God for giving me a trailer. I am uncomfortable in a way because the sofa is old. I am sleeping on top of a pillow because the back bedroom the bed is so high I cannot get into it. And they got one air conditioning unit in there and it does not cover the whole trailer. Certain parts of the day it gets hot, but I still praise God that I have somewhere to be. (Mississippi Focus Group)

What have been things that prevented you from recovering?

Medical …my baby needs medicine right now, but CVS will not

take his Medicaid card and he catch pneumonia. He has a respiratory disease, and he catch pneumonia like three times a year. And I got a prescription right now and they are like “we are not taking that” you know and it is just I am scared to transfer and then I am scared not to…(Georgia Focus Group).

What have been things that prevented you from recovering?

Lack of Financial SupportWell, like with me I am just staying in an old

trailer that was there. I had no help to fix it, I am on low income, I am on disability. But I just don’t have money to fix it. But I have not had any help from nobody so I am just doing the best I can, what can I do about it? (Mississippi Focus Group)

Difficulty in Obtaining Services The “runaround”

…it is the most frustrating thing is to call a number and they tell you they’re going to be able to help you but then when you call that number, “Right, but let me give you another number you can call” and then you call that number “Here’s another number you can call,” and you’re sittin’ there with a list of numbers and you call that whole page [but] you still have nothing (Georgia Focus Group).

Difficulty in Obtaining Services

Psychological status It is like we have lost our hope. No one answers our phone

calls, no one calls us back, you know. We have been left out. By asking certain questions or asking for something that we need, desperately need, and it just “Call this number, well, call this number, call this number.” I had six in one day, different ones to call and nobody had any answers for me. So that has been a very long drawn out thing. Getting the answers as to who do we talk to. (Mississippi Focus Group)

Discussion Point #5 A lack of concrete resources and difficulty

obtaining services was expressed as barriers to recovery

What type of resources are available to you? What agencies can assist you post-disaster?

Resources for Recovery Project REDD produces the Texas State Guide

to Supports and Services for Individuals with Disabilities and their Families Affected by Disaster

Locate resources and agencies in your state or area

What has helped you recover from Hurricane Katrina?

Um, I guess mainly the support from people here, from my church. Just from family and friends…So basically it has been relationships that have been the strongest piece, I think. Cause even with working with persons with some of the other agencies there have been relationships that have been developed from that communication and that contact with persons from other agencies. That is basically what it has been, relationships. (Georgia Focus Group)

What has helped you recover from Hurricane Katrina?

Prayer and my people. My son and my sister. Out of thirteen of us I only have two left. So like, if I need something I call my sister. She needs something, if I got it I call her. My mother and my father always teached us…nothin’ like your own. (Baton Rouge Focus Group)

What has helped you recover from Hurricane Katrina?

• What became apparent after interviewing all of the groups was that, without exception, every participant in each of the focus groups was still recovering from the disaster- none saw themselves as having “recovered.”

• Recovery was seen as an ongoing process that the participants were overwhelmingly still experiencing.

Discussion #6 Think about your own network of support.

What would be your supports in assisting you with your recovery? Who would assist you?

Supports in Disaster Recovery Family Friends Faith/Church Neighbors Community Social Agencies Government Agencies

Context of Displacement I think it’s more then money, it’s …knowing where

you live, the ground that you walk on and when you wake up you know where you are and, you know, it’s just your whole life has changed. I don’t think you’ll ever really recover because you’ll never get back what had. Everybody’s lost friends and family is scattered all around the country… (Houston Focus Group)

Context of Displacement You know when that storm hit, uh, my home is the only two

story in that area. I had, what, thirteen, fifteen neighbors over there. Thirteen, fifteen neighbors over there at my house. Didn’t know them, didn’t know their names. Didn’t know they stayed around the corner, but I know that I was the only shelter that they had and I took them all in. ..About three days later, Coast Guard came and and got everybody and I stayed…in that house over three weeks. (New Orleans Focus Group)

Context of Displacement I been around the world at least six to seven times. Red

Ocean, Pacific Ocean, Gulf War, Atlantic…I been around the world to Egypt- and they always trained us for when the ship [might] sink. And since 1987 we never had one experience where…I had to worry about ships sinking in the middle of the ocean…but here I am in my own home, and I’m seeing water rise above me, trying to knock a vent out on the roof thinking I’m going to drown right there in my own home. (New Orleans Focus Group)

As a group, policy and evaluation studies imply that, following a disaster, people with disabilities are likely to need support that …

Is more intensive in nature Involves multiple areas of support

(transportation, mobility, self-care, financial, daily living, employment housing, etc)

Is sustained over time Will enable them equitable access to

disaster-related services

Photo by Kendall Kessel; April 2006

Photo by Kendall Kessel; April 2006